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Overview: Tocilizumab is used to treat several conditions, including certain types of arthritis, cytokine release syndrome, and COVID-19. It works by blocking the effects of a protein, called interleukin-6 (IL-6), that causes inflammation. Common side effects include common cold symptoms, headaches, and pain where the needle went in. Serious side effects can include severe infections and liver problems. Tell your health care provider right away if you think you have an infection or if you get symptoms such as a fever, sweats, chills, or muscle aches.

Uses

What is tocilizumab used for?

Tocilizumab is commonly used to treat the following conditions.

  • Rheumatoid arthritis (RA), which is an autoimmune condition that causes your immune system to attack the lining of your joints
  • Giant cell arteritis (GCA), which is a condition that causes inflammation in your arteries (blood vessels that carry oxygen from your heart to the rest of your body)
  • Systemic sclerosis-associated interstitial lung disease (SSc-ILD), which is a condition that causes inflammation and scarring in your lungs
  • Polyarticular juvenile idiopathic arthritis (PJIA), which is a condition that causes inflammation of the joints in children
  • Systemic juvenile idiopathic arthritis (SJIA), which is a condition that causes inflammation of the joints and other tissues in the body in children
  • Cytokine release syndrome (CRS), which is a condition caused when your immune system responds too much to an infection or certain medicines
  • COVID-19 (coronavirus disease 2019), in serious cases for certain people who are hospitalized

These uses may vary depending on the specific tocilizumab product prescribed. Tocilizumab may also be used for other conditions as determined by your health care provider.

How does tocilizumab work (mechanism of action)?

Tocilizumab works by blocking the effects of a protein, called interleukin-6 (IL-6), that causes inflammation in your body. Blocking the effects of IL-6 can help reduce inflammation and treat symptoms of certain inflammatory conditions.

How is tocilizumab supplied (dosage forms)?

Brands and other names

  • Actemra
  • Avtozma
  • Tofidence
  • Tyenne

Dosage forms and strengths

  • 162 mg/0.9 mL single-dose prefilled syringes
  • 162 mg/0.9 mL single-dose autoinjectors

Tocilizumab is also available in other injectable forms that are given by a health care provider.

How should I store tocilizumab?

Depending on why you are using tocilizumab, it may be given at home or by a health care provider in a hospital or clinic. If you will store tocilizumab at home, follow the instructions given by your health care provider. Tocilizumab should be stored in a refrigerator, between 36 F and 46 F (2 C and 8 C). Some tocilizumab products may be stored at room temperature, up to 77 F (25 C), for shorter periods of time. Do not freeze the medicine, and keep it in its original package to protect it from light. Ask your pharmacist or other health care provider how to store the specific tocilizumab product you are using.

Side Effects

What are the most common side effects of tocilizumab?

The most common side effects of tocilizumab are listed below. Tell your health care provider if you have any of these side effects that bother you.

  • Infection in the nose or throat, sore throat, or common cold symptoms
  • Headache
  • High blood pressure (hypertension)
  • Pain, itching, swelling, or redness near where the needle went in
  • Changes in liver tests

There may be other side effects of tocilizumab that are not listed here. Contact your health care provider if you think you are having a side effect of a medicine. In the U.S., you can report side effects to the FDA at www.fda.gov/medwatch or by calling 800-FDA-1088 (800-332-1088). In Canada, you can report side effects to Health Canada at www.health.gc.ca/medeffect or by calling 866-234-2345.

What are the serious side effects of tocilizumab?

While less common, the most serious side effects of tocilizumab are described below, along with what to do if they happen.

Severe Allergic Reactions. Tocilizumab may cause allergic reactions, including a specific type of allergic reaction called DRESS. DRESS stands for drug reaction with eosinophilia and systemic symptoms. It is also sometimes called multi-organ hypersensitivity. This is a reaction that can affect multiple parts of the body, including your liver, kidneys, and heart. Stop using the medicine and get help right away if you have any of the following symptoms of a serious allergic reaction.

  • Breathing problems or wheezing
  • Racing heart
  • Itching, skin rash, or pale red bumps on the skin called hives
  • Fever or general ill feeling
  • Swollen lymph nodes
  • Swelling of the face, lips, mouth, tongue, or throat
  • Shortness of breath, trouble swallowing, or throat tightness
  • Swelling in your feet, ankles, or legs
  • Nausea or vomiting
  • Dizziness, feeling lightheaded, or fainting
  • Stomach cramps
  • Joint pain
  • Dark-colored pee
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Infections. Tocilizumab can increase your risk of infections, including serious infections. The risk is higher if you use certain other medicines. Call your health care provider right away if you have an infection or any of the following symptoms.

  • Burning or stinging when you pee, or peeing more than usual
  • Coughing, or coughing up blood
  • Fever, sweats, chills, muscle aches, or tiredness
  • Shortness of breath
  • Diarrhea or stomach pain
  • Weight loss
  • Sores 

Reactivated Infections. Some types of microbes that cause infections (such as bacteria or viruses) can remain in the body after you recover from that infection. When a microbe stays in the body but does not cause an infection, it is called a “latent” microbe. Tocilizumab may increase your risk of a latent microbe becoming active again, causing an infection. Before you start treatment with tocilizumab, tell your health care provider if you have ever had tuberculosis (TB), hepatitis B, shingles (herpes zoster), or any other serious infections.

Gut Tears (Perforation). Tocilizumab can increase your risk of tears (perforation) in your gut. The risk is higher if you have certain stomach problems or take certain other medicines. Stop using tocilizumab and tell your health care provider right away if you have any of the following symptoms.

  • Fever
  • Severe stomach pain that will not go away
  • A change in your bowel habits

Liver Damage. Liver damage, also called hepatotoxicity, can happen when using tocilizumab. Call your health care provider right away if you have any of the following symptoms of liver damage.

  • Nausea or vomiting
  • Stomach or belly pain
  • Fever or confusion
  • Weakness or unusual tiredness
  • Itching
  • Loss of appetite
  • Light-colored poop
  • Dark-colored urine (pee)
  • Your skin or the whites of your eyes turning yellowish in color (also called jaundice)

Low Neutrophil Levels (Neutropenia). Tocilizumab may cause low levels of a type of white blood cell (called neutrophils), which is known as neutropenia. Neutrophils help prevent infection. Having a low level of neutrophils may increase your risk of infection. Tell your health care provider right away if you have any of the following symptoms of low neutrophil levels.

  • Fever, chills, or sweats
  • Tiredness
  • Sore throat, coughing, or shortness of breath
  • Mouth or throat sores
  • Swollen lymph nodes

Severely Low Platelet Levels. Tocilizumab can cause you to have a severely low number of platelets in your blood, also called thrombocytopenia. Platelets help to form blood clots. Having a low level of platelets may increase your risk of bleeding. Tell your health care provider if you have any of the following symptoms of low platelet levels.

  • Easy bruising or bleeding
  • Bleeding that does not stop
  • Nosebleeds

High Cholesterol Levels. Tocilizumab can cause high cholesterol levels. Keep all appointments with your health care provider to check your bloodwork.

Cancer. Tocilizumab may affect your immune system, which could cause a new cancer to develop or cause a previously treated cancer to recur. Tell your health care provider about any new symptoms that you may get. 

Nerve Problems. A small number of people have developed nervous system problems, such as multiple sclerosis, while using tocilizumab. Tell your health care provider right away if you have any of the following symptoms.

  • Changes in mental function
  • Muscle weakness
  • Numbness or tingling
  • Poor coordination or dizziness
  • Trouble walking
  • Vision changes or vision loss

Warnings & Precautions

Who should not use tocilizumab?

Allergies to Ingredients. People who are allergic to any of the following should not use tocilizumab.

  • Tocilizumab
  • Actemra
  • Avtozma
  • Tofidence
  • Tyenne
  • Any of the ingredients in the specific product dispensed

Your pharmacist can tell you all of the ingredients in the specific tocilizumab products they stock.

What should I know about tocilizumab before using it?

Do not use tocilizumab unless it has been prescribed to you by a health care provider. Use it as prescribed.

Do not share tocilizumab with other people, even if they have the same condition as you. It may harm them.

Keep tocilizumab out of the reach of children. Since this medicine should be kept in a refrigerator, take special precautions to keep it away from children who also use the refrigerator.

There are multiple forms of tocilizumab available. If you are using tocilizumab at home, read and follow the instructions for the product you have and make sure you understand how to prepare and use it properly. If you have any questions, talk to your health care provider.

Keep all appointments with your health care provider, including to check your bloodwork or for other lab tests.

People who are 65 and older can be at greater risk of some side effects from tocilizumab. Talk to your health care provider about your risks if you are in this age group.

What should I tell my health care provider before using tocilizumab?

Tell your health care provider about all of your health conditions and any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. This will help them know if tocilizumab is right for you.

In particular, make sure that you discuss any of the following.

Vaccines. Talk with your health care provider about any vaccines that you may need. You should not receive certain vaccines right before or while using tocilizumab. Tell your health care provider about any vaccines you have recently received or have scheduled.

Risk of Infection. Tocilizumab increases your risk of certain infections. It is important to tell your health care provider if you have any of the following. These might increase your chance of having an infection.

  • A current infection
  • Get a lot of infections or have infections that come back
  • Been in close contact with someone who has tuberculosis (TB)
  • Live, have lived in, or have traveled to parts of the country where there is a risk of certain fungal infections 

Planned Surgery. Tell your health care provider if you have any planned surgeries or medical procedures.

Other Medicines and Supplements. Tocilizumab may interact with other medicines and supplements. Before using tocilizumab, tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using. See the Interactions section for more details.

Pregnancy. Tocilizumab may harm an unborn baby. Tell your health care provider if you are pregnant or plan to become pregnant.

Breastfeeding. It is not known if tocilizumab passes into breast milk. Tell your health care provider if you are breastfeeding or plan to breastfeed. Your health care provider will let you know if you should use tocilizumab while breastfeeding.

Interactions

Does tocilizumab interact with foods or drinks?

There are no known interactions between tocilizumab and foods or drinks.

It is unknown if drinking alcohol will affect tocilizumab.

Does tocilizumab interact with other medicines (drug interactions)?

Always tell your health care provider about any prescription or over-the-counter (OTC) medicines, vitamins/minerals, herbal products, and other supplements you are using.

In particular, make sure that you discuss if you are using any of the following before using tocilizumab.

  • ny other medicines to treat rheumatoid arthritis
  • Omeprazole (Prilosec), which is a medicine used to treat gastroesophageal reflux disease (GERD)
  • Warfarin, which is a blood thinner
  • Cyclosporine (Gengraf, Neoral, Sandimmune, and others), which is a medicine that suppresses your immune system
  • Theophylline (Elixophyllin, Theo-24), which is a medicine for asthma or certain other breathing problems
  • A birth control pill
  • A statin, such as atorvastatin (Lipitor and others), lovastatin (Altoprev), or simvastatin (Zocor), which is a medicine to lower cholesterol

This may not be a complete list of medicines that can interact with tocilizumab. Always check with your health care provider.

Does interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

Overdose/Missed Dose

What should I do if I accidentally use too much tocilizumab?

If you or someone else has used too much tocilizumab, get medical help right away, call 911, or contact a Poison Control center at 800-222-1222.

What should I do if I miss a dose of tocilizumab?

If you miss a dose, talk to your health care provider to find out when you should use your next dose.

Certain forms of tocilizumab are usually given by a health care provider in a hospital. In this case, your health care provider will make sure you are receiving tocilizumab as scheduled. If you miss an appointment to get your tocilizumab dose, call to make another appointment as soon as possible.